Medicare AdvantagePrior AuthLow impact
Haegarda (C1 esterase inhibitor, human) (Revised)
Humana·KY, SC · Allergy & Immunology, Internal Medicine·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana updated prior authorization requirements for Haegarda (C1 esterase inhibitor) used for hereditary angioedema prophylaxis. The policy now requires specific lab documentation including C1q levels and treatment by specialist physicians for Medicare and Medicaid members in Kentucky and South Carolina.
Action Required
By January 1, 2025: For any patients prescribed Haegarda for hereditary angioedema, ensure prior authorization requests include C1q lab levels, C4 levels, C1 inhibitor levels, documentation of specialist treatment by allergist/immunologist, and confirmation the medication is for prophylaxis. Claims will be denied without proper prior authorization meeting all specified criteria.